Body Image and Exercise Attitudes in Men with Prostate Cancer Undergoing Androgen Deprivation Therapy

Body Image Issues and
Attitudes Toward Exercise in
Men Diagnosed with
Prostate Cancer Undergoing
Androgen Deprivation
Therapy
Presentation
 
by
Caterina Gentili, 
PhD candidate
27
th
 September 2018 – CAR weekly
Background
Background
growing population 
of PCa survivors
Background
growing population 
of PCa survivors
Androgen Deprivation Therapy (ADT)
Background
growing population 
of PCa survivors
Androgen Deprivation Therapy (ADT)
Gold standard treatment
Received by 50% of PCa patients
(Chen et al., 2014; Ferlay et al., 2018)
Androgen Deprivation Therapy
Androgen Deprivation Therapy
Androgen Deprivation Therapy
Slowing cancer growth 
Androgen Deprivation Therapy
Slowing cancer growth 
Side effects:
-
Weight gain
-
Loss of muscle mass
-
Breast enlargement
-
Penile and 
testicular 
shrinkage
-
Lack of libido
-
Impotence
-
Incontinence 
-
Hot flushes
-
Fatigue
Etc.
Androgen Deprivation Therapy
Slowing cancer growth 
Side effects:
-
Weight gain
-
Loss of muscle mass
-
Breast enlargement
-
Penile and 
testicular 
shrinkage
-
Lack of libido
-
Impotence
-
Incontinence 
-
Hot flushes
-
Fatigue
Etc.
Quality of life
Sexuality
Body Image
(Harrington, Jones, E. G., & Badger, T., 2009)
What can patients do about it?
What can patients do about it?
Seek psychological help?
What can patients do about it?
Seek psychological help?
Awareness?
Access?
Acceptability?
What can patients do about it?
Seek psychological help?
Practical coping strategy: 
exercise
?
Awareness?
Access?
Acceptability?
What can patients do about it?
Seek psychological help?
Practical coping strategy: 
exercise
?
Awareness?
Access?
Acceptability?
 
Physical health
  
survival
  muscular and skeletal strength
  cardiorespiratory outcomes
  sexual functioning
  cancer progression
  fatigue
  cholesterol
What can patients do about it?
Seek psychological help?
Practical coping strategy: 
exercise
?
Awareness?
Access?
Acceptability?
 
Physical health
  
survival
  muscular and skeletal strength
  cardiorespiratory outcomes
  sexual functioning
  cancer progression
  fatigue
  cholesterol
 
Psychological health
 quality of life
 
masculine identity
 control over ADT side effects
 
body satisfaction
 
appearance satisfaction
 physical self efficacy
 stress management
What can patients do about it?
Seek psychological help?
Practical coping strategy: 
exercise
?
Awareness?
Access?
Acceptability?
Low adherence rates:
30% aerobic exercise
14% strength exercise
 
Physical health
  
survival
  muscular and skeletal strength
  cardiorespiratory outcomes
  sexual functioning
  cancer progression
  fatigue
  cholesterol
 
Psychological health
 quality of life
 
masculine identity
 control over ADT side effects
 
body satisfaction
 
appearance satisfaction
 physical self efficacy
 stress management
Aims
Aims
Further explore the impact of ADT-induced
appearance and functionality changes on patients’
body image.
Aims
Further explore the impact of ADT-induced
appearance and functionality changes on patients’
body image.
Investigate patients’ attitudes towards exercise and
potential  exercise barriers.
Methods
 
Methods
Participants
22 men diagnosed with PCa
ADT at least once in their life
M
age = 67.9 yo,
 SD 
= 9.99
Recruited through charities, social media, UWE press release
Methods
Participants
22 men diagnosed with PCa
ADT at least once in their life
M
age = 67.9 yo,
 SD 
= 9.99
Recruited through charities, social media, UWE press release
22 Semi structured interviews
30 - 50 min.
13 phone
9 face to face
audio recorded 
transcribed verbatim
  
Methods
Topics
ADT-induced bodily changes
Body image issues
Masculinity
Exercise
 
Methods
Topics
ADT-induced bodily changes
Body image issues
Masculinity
Exercise
 
Analyses
Thematic analysis
NVivo
Results: main themes
Results: main themes
Body feminization
I was somehow convinced
that I was turning into a
woman.
Enrico
Results: main themes
Body feminization
I was somehow convinced
that I was turning into a
woman.
Enrico
Breast enlargement
It’s embarrassing. I remember having
the grankid saying shouting to his
sister “my grandad got boobies!” you
know… which is not nice you know…”
 Carlo
Results: main themes
Body feminization
I was somehow convinced
that I was turning into a
woman.
Enrico
Breast enlargement
It’s embarrassing. I remember having
the grankid saying shouting to his
sister “my grandad got boobies!” you
know… which is not nice you know…”
 Carlo
Weight gain
I feel I am looking fatter as well as
feeling fatter… emh… I don’t want
to be carrying all this extra weight
around with me when I do that…”
Edoardo
Results: main themes
Body feminization
I was somehow convinced
that I was turning into a
woman.
Enrico
Breast enlargement
It’s embarrassing. I remember having
the grankid saying shouting to his
sister “my grandad got boobies!” you
know… which is not nice you know…”
 Carlo
Weight gain
I feel I am looking fatter as well as
feeling fatter… emh… I don’t want
to be carrying all this extra weight
around with me when I do that…”
Edoardo
Functionality loss
Now my energy levels aren’t as
great as they used to be. Before I
was able to walk 15 to 20 miles a
day. But those days have gone now
and I found that very sad.
Giovanni
Results: main themes
Body feminization
I was somehow convinced
that I was turning into a
woman.
Enrico
Breast enlargement
It’s embarrassing. I remember having
the grankid saying shouting to his
sister “my grandad got boobies!” you
know… which is not nice you know…”
 Carlo
Weight gain
I feel I am looking fatter as well as
feeling fatter… emh… I don’t want
to be carrying all this extra weight
around with me when I do that…”
Edoardo
Functionality loss
Sexual issues
Now my energy levels aren’t as
great as they used to be. Before I
was able to walk 15 to 20 miles a
day. But those days have gone now
and I found that very sad.
Giovanni
It’s upset… is uncomfortable, it’s
upset. (…) Obviously the physical
side of our relationship is not
totally fulfilled
Giovanni
Results: main themes
Exercise
Results: main themes
Exercise
Counterbalance ADT
Regular exercise does help to
keep your weight down…
Ludovico
Results: main themes
Exercise
Counterbalance ADT
Achievement and control
Regular exercise does help to
keep your weight down…
Ludovico
You are under still a little bit of control
(..) I don’t know how long I have got but
it’s just gratifying and reassuring that I
can still do things…
Michele
Results: main themes
Exercise
Counterbalance ADT
Time and energy levels
Achievement and control
Regular exercise does help to
keep your weight down…
Ludovico
You are under still a little bit of control
(..) I don’t know how long I have got but
it’s just gratifying and reassuring that I
can still do things…
Michele
I am working full time, and you are
tired after work. It is difficult to fit
exercise in your day
Mario
Results: main themes
Exercise
Counterbalance ADT
Time and energy levels
Achievement and control
Fear of negative evaluation
Regular exercise does help to
keep your weight down…
Ludovico
You are under still a little bit of control
(..) I don’t know how long I have got but
it’s just gratifying and reassuring that I
can still do things…
Michele
I am working full time, and you are
tired after work. It is difficult to fit
exercise in your day
Mario
You got somebody else in front of
you or next to you and you still think
“Oh they are quicker!”
Paolo
Conclusions
Conclusions
ADT side effects can have an impact on patients body image and masculine identity
Conclusions
ADT side effects can have an impact on patients body image and masculine identity
Body image issues are mostly dependent on body feminization
Conclusions
ADT side effects can have an impact on patients body image and masculine identity
Body image issues are mostly dependent on body feminization
Physically active patients find an effective coping strategy in exercise
Conclusions
ADT side effects can have an impact on patients body image and masculine identity
Body image issues are mostly dependent on body feminization
Physically active patients find an effective coping strategy in exercise
Future directions
I will further explore the topic quantitatively
Some patients might benefit from information and support for body image concerns
Patients who are not physically active might benefit from an exercise intervention
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The presentation by Caterina Gentili, PhD candidate, on body image issues and exercise attitudes in men diagnosed with prostate cancer undergoing androgen deprivation therapy sheds light on the challenges faced by this population. The background discusses the increasing number of prostate cancer survivors and the significance of androgen deprivation therapy as a standard treatment. The therapy, while effective in slowing cancer growth, brings about various side effects affecting quality of life, sexuality, and body image. Patients are encouraged to seek psychological help to cope with these challenges.

  • Prostate Cancer
  • Androgen Deprivation Therapy
  • Body Image
  • Exercise Attitudes

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  1. Body Image Issues and Attitudes Toward Exercise in Men Diagnosed with Prostate Cancer Undergoing Androgen Deprivation Therapy Presentation by Caterina Gentili, PhD candidate 27thSeptember 2018 CAR weekly

  2. Background

  3. Background growing population of PCa survivors

  4. Background growing population of PCa survivors Androgen Deprivation Therapy (ADT)

  5. Background growing population of PCa survivors Androgen Deprivation Therapy (ADT) Gold standard treatment Received by 50% of PCa patients (Chen et al., 2014; Ferlay et al., 2018)

  6. Androgen Deprivation Therapy

  7. Androgen Deprivation Therapy

  8. Androgen Deprivation Therapy Slowing cancer growth

  9. Androgen Deprivation Therapy Slowing cancer growth Side effects: - Weight gain - Loss of muscle mass - Breast enlargement - Penile and testicular shrinkage - Lack of libido - Impotence - Incontinence - Hot flushes - Fatigue Etc.

  10. Androgen Deprivation Therapy Slowing cancer growth Side effects: - Weight gain - Loss of muscle mass - Breast enlargement - Penile and testicular shrinkage - Lack of libido - Impotence - Incontinence - Hot flushes - Fatigue Etc. Quality of life Sexuality Body Image (Harrington, Jones, E. G., & Badger, T., 2009)

  11. What can patients do about it?

  12. What can patients do about it? Seek psychological help?

  13. What can patients do about it? Awareness? Access? Acceptability? Seek psychological help?

  14. What can patients do about it? Awareness? Access? Acceptability? Seek psychological help? Practical coping strategy: exercise?

  15. What can patients do about it? Awareness? Access? Acceptability? Seek psychological help? Practical coping strategy: exercise? Physical health survival muscular and skeletal strength cardiorespiratory outcomes sexual functioning cancer progression fatigue cholesterol

  16. What can patients do about it? Awareness? Access? Acceptability? Seek psychological help? Practical coping strategy: exercise? Psychological health quality of life masculine identity control over ADT side effects body satisfaction appearance satisfaction physical self efficacy stress management Physical health survival muscular and skeletal strength cardiorespiratory outcomes sexual functioning cancer progression fatigue cholesterol

  17. What can patients do about it? Awareness? Access? Acceptability? Seek psychological help? Low adherence rates: 30% aerobic exercise 14% strength exercise Practical coping strategy: exercise? Psychological health quality of life masculine identity control over ADT side effects body satisfaction appearance satisfaction physical self efficacy stress management Physical health survival muscular and skeletal strength cardiorespiratory outcomes sexual functioning cancer progression fatigue cholesterol

  18. Aims

  19. Aims Further explore the impact of ADT-induced appearance and functionality changes on patients body image.

  20. Aims Further explore the impact of ADT-induced appearance and functionality changes on patients body image. Investigate patients attitudes towards exercise and potential exercise barriers.

  21. Methods

  22. Methods Participants 22 men diagnosed with PCa ADT at least once in their life Mage = 67.9 yo, SD = 9.99 Recruited through charities, social media, UWE press release

  23. Methods Participants 22 men diagnosed with PCa ADT at least once in their life Mage = 67.9 yo, SD = 9.99 Recruited through charities, social media, UWE press release 22 Semi structured interviews 30 - 50 min. 13 phone 9 face to face audio recorded transcribed verbatim

  24. Methods Topics ADT-induced bodily changes Body image issues Masculinity Exercise

  25. Methods Topics ADT-induced bodily changes Body image issues Masculinity Exercise Analyses Thematic analysis NVivo

  26. Results: main themes

  27. Results: main themes Body feminization I was somehow convinced that I was turning into a woman. Enrico

  28. Breast enlargement Results: main themes It s embarrassing. I remember having the grankid saying shouting to his sister my grandad got boobies! you know which is not nice you know Carlo Body feminization I was somehow convinced that I was turning into a woman. Enrico

  29. Breast enlargement Results: main themes It s embarrassing. I remember having the grankid saying shouting to his sister my grandad got boobies! you know which is not nice you know Carlo Weight gain Body feminization I feel I am looking fatter as well as feeling fatter emh I don t want to be carrying all this extra weight around with me when I do that I was somehow convinced that I was turning into a woman. Edoardo Enrico

  30. Breast enlargement Results: main themes It s embarrassing. I remember having the grankid saying shouting to his sister my grandad got boobies! you know which is not nice you know Carlo Weight gain Body feminization I feel I am looking fatter as well as feeling fatter emh I don t want to be carrying all this extra weight around with me when I do that I was somehow convinced that I was turning into a woman. Edoardo Enrico Functionality loss Now my energy levels aren t as great as they used to be. Before I was able to walk 15 to 20 miles a day. But those days have gone now and I found that very sad. Giovanni

  31. Breast enlargement Results: main themes It s embarrassing. I remember having the grankid saying shouting to his sister my grandad got boobies! you know which is not nice you know Carlo Weight gain Body feminization I feel I am looking fatter as well as feeling fatter emh I don t want to be carrying all this extra weight around with me when I do that I was somehow convinced that I was turning into a woman. Edoardo Enrico Functionality loss Now my energy levels aren t as great as they used to be. Before I was able to walk 15 to 20 miles a day. But those days have gone now and I found that very sad. Sexual issues It s upset is uncomfortable, it s upset. ( ) Obviously the physical side of our relationship is not totally fulfilled Giovanni Giovanni

  32. Results: main themes Exercise

  33. Counterbalance ADT Regular exercise does help to keep your weight down Results: main themes Ludovico Exercise

  34. Counterbalance ADT Regular exercise does help to keep your weight down Results: main themes Ludovico Achievement and control You are under still a little bit of control (..) I don t know how long I have got but it s just gratifying and reassuring that I can still do things Exercise Michele

  35. Counterbalance ADT Regular exercise does help to keep your weight down Results: main themes Ludovico Achievement and control You are under still a little bit of control (..) I don t know how long I have got but it s just gratifying and reassuring that I can still do things Exercise Michele Time and energy levels I am working full time, and you are tired after work. It is difficult to fit exercise in your day Mario

  36. Counterbalance ADT Regular exercise does help to keep your weight down Results: main themes Ludovico Achievement and control You are under still a little bit of control (..) I don t know how long I have got but it s just gratifying and reassuring that I can still do things Exercise Michele Time and energy levels I am working full time, and you are tired after work. It is difficult to fit exercise in your day Mario Fear of negative evaluation You got somebody else in front of you or next to you and you still think Oh they are quicker! Paolo

  37. Conclusions

  38. Conclusions ADT side effects can have an impact on patients body image and masculine identity

  39. Conclusions ADT side effects can have an impact on patients body image and masculine identity Body image issues are mostly dependent on body feminization

  40. Conclusions ADT side effects can have an impact on patients body image and masculine identity Body image issues are mostly dependent on body feminization Physically active patients find an effective coping strategy in exercise

  41. Conclusions ADT side effects can have an impact on patients body image and masculine identity Body image issues are mostly dependent on body feminization Physically active patients find an effective coping strategy in exercise Future directions I will further explore the topic quantitatively Some patients might benefit from information and support for body image concerns Patients who are not physically active might benefit from an exercise intervention

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